Provider Demographics
NPI:1154986982
Name:TROMBLY, PRUDENCE (LCMHC)
Entity type:Individual
Prefix:
First Name:PRUDENCE
Middle Name:
Last Name:TROMBLY
Suffix:
Gender:
Credentials:LCMHC
Other - Prefix:
Other - First Name:PRUDENCE
Other - Middle Name:
Other - Last Name:BALLOU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:102 S WINOOSKI AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-7406
Mailing Address - Country:US
Mailing Address - Phone:802-488-6920
Mailing Address - Fax:802-488-6919
Practice Address - Street 1:1138 PINE ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-5353
Practice Address - Country:US
Practice Address - Phone:802-488-6000
Practice Address - Fax:802-488-6919
Is Sole Proprietor?:No
Enumeration Date:2019-05-07
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068-0111674101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health